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Predicting Acute Kidney Injury Following Non-Emergent Cardiac Surgery: A Preoperative Scorecard
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  • Ahmed Mokhtar,
  • Karthik Tennankore,
  • Steve Doucette,
  • Christine Herman
Ahmed Mokhtar
Dalhousie University Faculty of Medicine
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Karthik Tennankore
Dalhousie University Faculty of Medicine
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Steve Doucette
Nova Scotia Health Authority
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Christine Herman
Dalhousie University
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Abstract

Objective: To determine the predictors of postoperative AKI following non-emergent cardiac surgery among patients with variable preoperative eGFR levels. Methods: Retrospective study of patients who underwent elective or in-hospital cardiac surgical procedures performed between January 2006 and November 2015. The procedures included isolated CABG, isolated AVR or combined CABG and AVR. The primary outcome AKI (any stage) following non-emergent cardiac surgery utilizing the 2012 KDIGO criteria. Patients were categorized based the following renal outcomes: mild AKI, severe AKI (KDIGO stage 2 or 3) and post-operative dialysis.. Results: A total of 6713 patients were included in our study. The mean age was 66.8 years (SD ± 10.3), with 76.2% being males. A total of 4487 patients had normal or mildly decreased eGFR (G1 or G2) preoperatively (66.8%), while 1960 patients were in the G3 category (29.1%). Only 266 patients (3.9%) had G4 or worse renal function. A total of 1489 (28.5%) patients experienced post-operative AKI. The need for postoperative dialysis occurred in 4.2% of the AKI subgroup. In-hospital mortality was higher among the AKI subgroup (7.3% vs 0.5%, p<0.0001). In an adjusted model, a lower pre-operative eGFR category was the strongest predictor of AKI. A practical scorecard for the preoperative estimation of severe AKI for non-emergent cardiac procedures incorporating these parameters was developed. Conclusions: Preoperative eGFR is the strongest predictor of post-operative AKI in individuals undergoing non-emergent cardiac surgery. A practical scorecard incorporating preoperative predictors of AKI may allow informed decision making and to predict AKI following non-emergent cardiac surgery

Peer review status:ACCEPTED

12 Oct 2020Submitted to Journal of Cardiac Surgery
14 Oct 2020Submission Checks Completed
14 Oct 2020Assigned to Editor
18 Oct 2020Reviewer(s) Assigned
13 Nov 2020Review(s) Completed, Editorial Evaluation Pending
13 Nov 2020Editorial Decision: Revise Major
26 Nov 20201st Revision Received
26 Nov 2020Submission Checks Completed
26 Nov 2020Assigned to Editor
26 Nov 2020Reviewer(s) Assigned
29 Dec 2020Review(s) Completed, Editorial Evaluation Pending
12 Jan 2021Editorial Decision: Revise Minor
16 Jan 20212nd Revision Received
18 Jan 2021Submission Checks Completed
18 Jan 2021Assigned to Editor
18 Jan 2021Reviewer(s) Assigned
18 Feb 2021Review(s) Completed, Editorial Evaluation Pending
19 Feb 2021Editorial Decision: Revise Minor
07 Mar 20213rd Revision Received
08 Mar 2021Submission Checks Completed
08 Mar 2021Assigned to Editor
08 Mar 2021Review(s) Completed, Editorial Evaluation Pending
08 Mar 2021Editorial Decision: Accept